Yun Qingping, Wang Shiyu, Chen Shanquan, Luo Hao, Li Bingyu, Yip Paul, Yu Xin, Yang Zhirong, Sha Feng, Tang Jinling
Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China.
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
EClinicalMedicine. 2024 Jan 16;67:102371. doi: 10.1016/j.eclinm.2023.102371. eCollection 2024 Jan.
Constipation is generally considered a common physical symptom of depression or a side effect of antidepressant treatments. However, according to the gut-brain axis hypothesis, the association between depression and constipation might be bi-directional. This study investigated the association between premorbid constipation and depression.
We conducted a retrospective cohort study using data from UK Biobank. Individuals free of depression between 2006 and 2010 were included. Constipation status was determined using diagnostic codes from electronic health records or a baseline questionnaire. Data on covariates, including socio-demographic characteristics, lifestyle factors, health conditions, and regular medication use, were also collected through a baseline questionnaire. The primary outcome is incident depression, which was extracted from hospital inpatient admissions, primary care, self-report, and death data from baseline to 2022. The secondary outcome is depressive symptoms, which was assessed by Patient Health Questionnaire-9 (PHQ-9) from an online survey in 2016. Cox proportional hazard regression models were employed to assess the prospective association between constipation and incident depression. Logistic regression models were used to assess its association with depressive symptoms.
Among the 449,459 participants included in the study, 18,596 (4.1%) experienced constipation at baseline, and 18,576 (4.1%) developed depression over a median follow-up period of 12.3 years. Premorbid constipation is associated with a 2.28-fold higher risk of depression. After adjusting the covariates, we found those with constipation still had a 48% higher risk of developing depression (adjusted hazard ratio [aHR] 1.48; 95% CI, 1.41-1.56) than those without constipation. Self-reported and diagnosed constipation were both associated with a higher risk of depression, with the aHR being 1.42 (95% CI: 1.34-1.51) and 1.66 (95% CI: 1.51-1.82), respectively. Participants with constipation were more likely to report depressive symptoms than people without (adjusted odds ratio 2.18; 95% CI, 1.97-2.43). These findings remained consistent in sensitivity analyses.
Diagnosed and self-reported constipation are both prospectively associated with an elevated risk of depression. These explorative findings suggest that constipation may be an independent risk factor or a prodromal symptom of depression. Gastroenterologists and primary care physicians should pay more attention to the depressive symptoms of their constipation patients.
The Shenzhen Science and Technology Program and the Strategic Priority Research Program of Chinese Academy of Sciences.
便秘通常被认为是抑郁症的常见躯体症状或抗抑郁治疗的副作用。然而，根据肠-脑轴假说，抑郁症与便秘之间的关联可能是双向的。本研究调查了病前便秘与抑郁症之间的关联。
我们使用英国生物银行的数据进行了一项回顾性队列研究。纳入2006年至2010年间无抑郁症的个体。便秘状态通过电子健康记录中的诊断代码或基线问卷来确定。还通过基线问卷收集了协变量数据，包括社会人口学特征、生活方式因素、健康状况和常规用药情况。主要结局是新发抑郁症，从基线到2022年的医院住院记录、初级保健、自我报告和死亡数据中提取。次要结局是抑郁症状，通过2016年在线调查中的患者健康问卷-9（PHQ-9）进行评估。采用Cox比例风险回归模型评估便秘与新发抑郁症之间的前瞻性关联。采用逻辑回归模型评估其与抑郁症状的关联。
在纳入研究的449459名参与者中，18596名（4.1%）在基线时经历过便秘，在中位随访期12.3年期间，18576名（4.1%）患上抑郁症。病前便秘与抑郁症风险高2.28倍相关。调整协变量后，我们发现便秘患者患抑郁症的风险仍比无便秘者高48%（调整后风险比[aHR]1.48；95%置信区间，1.41-1.56）。自我报告的便秘和诊断出的便秘均与较高的抑郁症风险相关，aHR分别为1.42（95%置信区间：1.34-1.51）和1.66（9 confidence interval: 1.51-1.82）。便秘参与者比无便秘者更有可能报告抑郁症状（调整后的优势比为2.18；95%置信区间，1.97-2.43）。这些发现在敏感性分析中保持一致。
诊断出的便秘和自我报告的便秘均与抑郁症风险升高存在前瞻性关联。这些探索性发现表明，便秘可能是抑郁症的独立危险因素或前驱症状。胃肠病学家和初级保健医生应更加关注便秘患者的抑郁症状。
深圳市科技计划和中国科学院战略性先导科技专项。
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